Let’s say you are looking to buy a car. You think you might want to buy a Volvo so you go down to the Volvo dealer and check out the new models. But you are shocked by what you see. You realize that you really don’t need to spend $35 to $40,000, or more, on a new car, so you decide to visit the Subaru dealer. There you find very nice alternative models for thousands of dollars less. You are delighted to have a new Outback for about $27,000.

The above story is how private markets and market choices work for the vast majority of items that we purchase to meet most of our needs as human beings. However, it has become painfully obvious that healthcare is an area where the normal model of markets and market choices do not apply. I’ll use a personal example.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

Yet the United States (US) has the most expensive healthcare system in the world, by far—there really isn’t a close second—spending just under 18% of GPD and around $8,500.00 per person on healthcare. One might assume that given that type of expense, we would be getting a lot more than other countries in return for our investment. According to the research provided by Mirror, Mirror, from the Commonwealth Fund, the US sadly underperforms and often fails relative to other developed countries on major measures of performance.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

When the Affordable Care Act, commonly referred to as Obamacare was under consideration there was an unrelenting partisan attack against both the proposed legislation and the president who proposed it. We were told that millions would lose insurance coverage, that the cost of medical care would skyrocket, and that government bureaucrats would be interfering with the health care relationship between us and our physicians. We were told that death panels would be making decisions to end the life of the elderly and infirm. We were told all sorts of things that were so ridiculous that I cannot recall them. The fact is we were told lies. Interestingly and importantly none of these things have occurred. The Affordable Care Act was designed to increase the extent of medical insurance coverage and the corresponding access to health care permitted by insurance coverage. The Affordable Care Act was also designed to slow the growth of health care costs. While it is true that there were initial technical glitches in its rollout, now a year after people could begin to enroll, and still only months after the initiation of most of its provisions it is clearly apparent that it is doing just what it was designed and implemented to do. Yes, the Affordable Care Act, Obamacare, is a success.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website

Ok, I realize I am being somewhat provocative. But there is a real and very serious issue, which I am groping to address in a more precise manner.

In my last blog I described the contemporary moral setting from a philosophical perspective as one in which no single substantive normative moral perspective can resolve moral questions, such as the boundaries of human life and the scope of individual rights, with final moral authority. This is just to say, more simply and obviously when we reflect upon it, that in democratic, secular America, ethics, both philosophically and practically, becomes inextricably linked to public discourse in politics and public policy.

When bioethicists ask questions and make arguments about abortion, physician assisted suicide, stem cell research and cloning, and many other similar issues that pertain to questions about the value of human life in relation to both individual rights and societal goals, we have no privileged moral authority from which to draw. As bioethicists we engage in procedural, persuasive discourse, based on conventional moral principles that most often conflict, which is why there is moral dilemma or problem requiring analysis and prioritization. Our purpose in defending a particular moral position is to win assent from others. In short, for a bioethicist to promote a moral position, it is implicitly an attempt to build a consensus among readers and listeners that will hopefully impact public opinion about a particular moral problem or question. Moreover, to the extent these questions have public policy ramifications, and practically all do, it means that moral discourse is also oriented to effect change and function as a medium in which bioethicists often speak as advocates about how moral options should be framed as public policy positions in a democratic society.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

On the very last day of the 2014 legislative session, the New York Senate passed “The Compassionate Care Act” (S.1682-A, Savino) approving the legalization of medical marijuana. The Assembly had previously passed a companion bill (A.6357-A, Gottfried). The Senate bill has been sent to Governor Cuomo for his signature. The governor endorsed the bill in the legislature, but as of July 4, 2014, has yet to sign it.

New York medical marijuana proponents have been advocating for the availability of cannabis for several years. Neighboring states Connecticut, New Jersey, and Vermont, and 18 other states and the District of Columbia currently allow medical marijuana. However, last minute compromise changes to the New York law will severely restrict access to medical cannabis. In fact, the limitations are so rigid that some might say the bill is a hallow shell, a sham, one designed to appear to allow medical marijuana yet really not. Regardless of how one feels about medical cannabis, to hype the public into believing that marijuana will be available for medical purposes and then establishing barriers to its accessibility that is a fraud. It would be unconscionable to raise the hopes of distressed patients, many suffering with chronic and painful conditions, only to see those hopes dashed.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

Recently, the Governor of Tennessee signed into law a bill, SB 1391, which criminalizes a woman who has had a baby with drug-related complications. As a result babies born with addictions due to drug use by the mother during pregnancy will be grounds for the mother being charged with aggravated assault, which could result in sentence of up to 15 years in prison for the mother. The concerns of the state legislators who promoted and passed this bill were over a condition in newborns called neonatal abstinence syndrome (NAS). This condition results from exposure to addictive drugs while in the mother’s womb. In 2013 the Tennessee state Health Department reported 921 babies born with NAS and 278 cases so far in the past four months. The stated goal of the law was to reduce the number of babies born with this condition. But is criminalizing drug use during pregnancy, in this first of its kind state law, the most effective way of accomplishing this goal?

It is important to note that the bill was passed against the strong objections of women’s rights groups as well as health care and addiction specialty groups. First of all these experts agree that cause more harm to babies as pregnant women will be afraid to seek medical care.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

In my last blog I alluded to the effect of an assumed point of view, particularly a set of ideological set of assumptions around which a community is organized, has on the way we interpret data about how we perceive risks and benefits and make decisions about a range of issues. I was applying this perspective to public health perspectives such as the risks of gun ownership and forgoing vaccinations. In this blog, I will sketch out a theoretical approach for how humans process and understand information a bit more and conclude with some questions for my next blog about how to understand the obligations of those who are in the best positions to understand public health data, such as the better educated and healthcare workers.

We often assume that most people are capable of coming to objective and fair beliefs and reasonable decisions about various empirical topics, e.g. the effects of climate change, if only we have access to valid, scientific information. Thus, we often further assume that the goal of having more enlightened people to make more enlightened decisions about public health issues, or for that matter political issues and most other issues of public interest, is simply a matter of bringing to bear more complete and clear knowledge for people to understand. This is the assumption that Dan Kahan (a law and psychology professor from Yale Law School) and his research team calls the “More Information Hypothesis”. However recent research shows that this hypothesis is simply not true—in fact the more information people on opposite sides of an issue get, the more divided and intractable the conflict becomes. The simple fact of making more information accessible clearly does not resolve most public issues that are connected to well-established ideological and philosophical perspectives.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

I have written on this blog about the topic of stem cell tourism and the different strategies that have been proposed to stop the phenomenon. Just to provide a background on the topic from a previous blog: stem cell tourism is used to describe an internet-based direct-to-consumer advertised industry where clinics offer untested and unproven stem cell interventions as bonafide therapies to patients with a range of diseases and injuries including Parkinson’s disease, multiple sclerosis, ALS, blindness, cancer, cerebral palsy, spinal cord injury and many others. Basically there is no scientific evidence of safety of efficacy of these modalities to offer them on a for-profit basis to patients. The term was originally coined as a form of tourism because patients traveled from countries like the U.S., U.K., Canada and Australia to clinics in countries with lax regulations, but this simply is not the case anymore. There are several clinics within highly regulated countries like U.S. that offer stem cell interventions.

Of the several strategies people have discussed, one of the first has been on the topic of providing education to patients and the public. Here, people argue that providing education on the dangers of stem cell tourism might actually sway patients to not undertake unproven stem cell interventions. As some scholars have mentioned, education might not be as effective because it depends on a “rationale actor model” where we assume that patients will behave rationally and make choices based on weighing the harms and benefits of seeking unproven treatments. More so, such an argument does not sufficiently consider the hope patients have to ameliorate their disease, reduce pain or other symptoms, and increase their quality of life. While these counterarguments are certain rational and likely to be true, there is yet no solid evidence showing whether education on stem cell tourism is effective at swaying people from traveling for unproven interventions. But even if before we go into whether education might influence a patient’s decision to travel for unproven stem cell treatments, I think we need to assess the role of patient education in medicine.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

The case of the 13 year-old California girl, Jahi McMath, declared brain dead following a tonsillectomy has created another media frenzy. This is truly a tragic story. Apparently Jahi underwent tonsil surgery and two other procedures on December 9, 2013 to help her better manage sleep apnea. Following the surgery she was awake but shortly thereafter went into cardiac arrest and was placed on a ventilator. By December 11, physicians made a medical determination of brain death.

From the parent’s point of view, one can only imagine the shock and disbelief they have been experiencing. Their young child went to a major medical center where highly skilled physicians were going to perform what was assumed to be relatively low risk procedures. Jahi had apparently had some worries herself about not waking up following anesthesia. Like all supportive, loving parents they assured she was in good hands and no doubt reminded her of how important it was to have these procedures done in order to deal with what could be a life threatening medical condition in sleep apnea. They fully expected she would be fine and return to normal. Instead, she is on a mechanical breathing machine, which is supporting her breathing and heartbeat, and her physicians now say she’s dead.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

There are some ominous social and political trends currently in American society on which the field of bioethics should focus more attention. In this informal and admittedly polemical blog, I would like to briefly explore a couple of them.

Governors from about half of the states, mostly from the Tea Party GOP, have invoked their constitutional right to deny healthcare coverage to individuals in their states who make less that 138% of the federal poverty level. These governors calmly claim that pragmatism, not politics, is the basis for their decision to refuse their states the opportunity to participate in the Medicaid expansion program under the Affordable Care Act (ACA). It’s just too costly and the Medicaid program is broken, so they say.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.